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General NPI Number Information
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NPI Number | 1477295368
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Entity Type | Organization
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Legal Business Name | CLEMENT RAINBOW MODERN DENTISTRY, PC
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Dates
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Enumeration Date | 04/11/2022
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 3675 S RAINBOW BLVD STE 105
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City | LAS VEGAS
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State | NV
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Zip | 89103-1059
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Country | US
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Telephone | 702-602-2196
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Fax | 702-444-2325
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Provider Business Mailing Address
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Address Line | PO BOX 920050
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City | DALLAS
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State | TX
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Zip | 75392-0050
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Country | US
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Telephone | 714-845-8890
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Fax | 303-952-0852
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Authorized Official
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Title or Position | OWNER/DMD
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Name | JENNIFER CLEMENT
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Credential |
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Telephone | 701-601-2196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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